الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Pregnancy is a physiological process but it may be associated with certain risks to health and life of both the mother and child. Pregnancy can induce hypertension in normotensive women or aggravate already existing hypertension during pregnancy. Hypertensive disorders during pregnancy are associated with high maternofoetal mortality and morbidity in both underdeveloped and developed countries. Pregnancy Induced Hypertension (PIH) is one of the most common disorders seen in pregnancies. It is a disorder progresses into pre-eclampsia, a dangerous condition that can prove fatal to expectant mothers. It is defined as hypertension that occurs in pregnancy for the first time after 20weeks of gestation and disappears following delivery. PIH is strongly associated with adverse outcomes; it has serious short- and long-term complications to the mother, fetus, as well as newborn. Thus, major part of PIH management involves educating women regarding PIH risks and its proper self-care management such as: diet, exercise, self dipstick urine test, blood pressure measurement and treatment. Health education plays an important role in increasing women’s knowledge and awareness about PIH which inturn improve their self-care measures and increase their commitment with the care regimen, which ultimately will contribute to complications reduction. The maternity nurse plays a major role in the health education which is a step for better management of PIH to improve pregnancy outcomes for the woman and her offsprings. Therefore this study aimed at evaluating the effect of implementation of teaching program on maternal and neonatal outcome among primipara women suffering from PIH. To fulfill the study aim: - Settings: the study was conducted at antenatal unit in obstetric departments at six settings; Tanta University Hospital, El-Menshawy General Hospital and 4 MCH centers affiliated to the different available geographical health zones in Tanta. - Subjects: Convenient sample of 60 pregnant women diagnosed with pregnancy induced hypertension were included in the study and fulfilling the inclusive criteria, at their 3rd trimester of pregnancy with gestational weeks between (28-32), primipara . Singleton or twin pregnancy, and also women who had normal course of pregnancy (free from other medical and obstetrical complications. The sample was one group, study sample 60 pregnant women diagnosed with pregnancy induced hypertension who were the health education sessions were provided to them. - Tools of data collection: to achieve the aim of the study the following tools were used: Tool I: A structured interview schedule included three parts as following: Socio-demographic characteristics as age, level of education, marital status, place of residence, occupation, type of family, number of family members, family’s income level, family history of Hypertension or (PIH), and also address and mobile or phone number, Reproductive history such as ; number of gravid, problems with previous pregnancy, number of abortions, duration of current pregnancy (gestational weeks), antenatal booking and attendance of antenatal care classes regarding PIH, and History of present pregnancy as; detection time of PIH, type/degree of PIH, degree of blood pressure , associated symptoms as (headache, visual disturbances, blurring, flashing, nausea, vomiting, and upper abdominal pain, and also compliance to treatment. Tool II: Structured PIH women’s Knowledge Interview sheet: it included data related to Part 1: assessment of women’s knowledge regarding PIH as; definition, classifications, etiology, signs and symptoms, high risk groups, effect of PIH on pregnancy (maternal and fetal/neonatal complications), diagnostic testing, and therapeutic management. Part 2: assessment of women’s knowledge regarding self-care management of PIH as; Self- monitoring of body weight, Correct measurement of blood pressure, Self- monitoring of urinary dipstick test, Selfmonitoring of edema, Self identification of danger signs and also self-monitoring of daily fetal movement. Part 3: assessment of women’s reported self care management regarding PIH. Tool III: Outcome assessment tool: it included data regarding the assessment of maternal and neonatal outcomes of the studied women contained two parts. Part I: maternal outcome assessment (presence of maternal distress, mode of Rupture of membranes- spontaneous or artificial, time of rupture of membranes (pre-mature or mature), type of delivery (normal or cesarean section), occurrence of complications during labor due to PIH such as abruption placenta, in addition convulsions, preterm labor, Disseminated intravascular coagulation (DIC), vaginal bleeding, pulmonary edema, acute renal failure and consequences of haemorrhage and postpartum haemorrhage, and also length of hospital stay and Part II: neonatal outcome assessment: included assessment of viability status-alive or stillborn, abnormal apgar score, need for resuscitation and oxygen administration, visible congenital malformation, birth weight measurement, gestation at delivery, and also neonatal complications such as; hypoglycemia or jaundice, signs of respiratory distress syndrome, admission of the neonate to intensive care unit, and length of hospital stay . The main findings of the current study can be summarized as follows: Concerning the socio-demographic characteristics of women: - The age range of the women was (25-30 and more) years old and the mean age of women were 25.13±3.45 years, more than two-third (71.7%) were from rural areas, more than the half (58.3%) finished secondary/diplom education, more than one-third (33.3%) their income weren’t enough and more than two-third (66.7%) had family history of hypertension. Reproductive history of women: - The majorities of the studied women (83.3%) hadn’t a history of abortion and also were primigravida. While all (100%) of the studied women hadn’t history of PIH in the previous pregnancy. - More than half of the studied women (53.3%) reported that they had their initial antenatal visit later after 12 weeks gestation, as well as the mean of antenatal visits was 4.37±0.99. Also, all of them did not attend health education classes especially related to PIH. History profile of current pregnancy: - The findings revealed that the majority of the studied women (86.7%) had PIH during their second trimester of pregnancy while the rest (13.3%) of them were diagnosed by PIH during third trimester. - About one-half of the studied women (50%) had blood pressure ranged from 140-149/90-99 mmHg. As well as more than two-third (66.6%) had negative urine test for proteinuria using random urinary dipstick test. - The majority (83.3%) of the studied women had symptoms of hypertension; headache was the most common PIH symptom reported among them. Concerning women’s knowledge regarding Pregnancy induced hypertension, before and after implementation of health educational sessions: - Slightly less than two-third (58.3%) of the studied women exhibited poor level of knowledge regarding PIH before health education sessions compared to three-quarter and less than one-quarter of them (75% and 20 % respectively) had good and fair level of knowledge regarding PIH after implementation of health educational sessions. Concerning women’s knowledge regarding self-care management of Pregnancy induced hypertension, before and after implementation of health educational sessions: - More than two-third (68.4%) of the studied women exhibited poor level of knowledge regarding self care management of PIH before implementation health education sessions compared to the majority (88.3 %) who had good level of knowledge regarding self care management of PIH after implementation of health educational sessions. Concerning women’s reported self-care management regarding PIH, before and after implementation of health educational sessions: - The majority (81.7%) of the studied women reported inadequate self-care management before implementation of health educational sessions compared to the majority (86.7 %) of them revealed adequate self-care management regarding dietary habits after health education sessions. - More than two-third (70%) of the studied women reported inadequate self-care management regarding daily living activities before implementation of health educational sessions while the majority (85 %) of them revealed adequate self-care management regarding daily living activities after implementation of health educational sessions. - More than two-third (63.3%) of the studied women had reported inadequate self-care management regarding common signs and symptoms before implementation of health educational sessions compared to slightly less than three-quarter (73.3 %) who had reported adequate self-care management related to common signs and symptoms after the implementation of health educational sessions. Maternal outcome assessment of the studied women: - The present study showed that the majority (95%) of the studied women hadn’t experience any complications of PIH during pregnancy or labor. - No admission to intensive care unit or recorded deaths from PIH complications were recorded among women. - The majority (96. 7%) of the studied women delivered by cesarean section. And also, the majority (91.7%) of them stayed at hospital for one day and discharged without any problems. Neonatal outcome assessment of the studied women: - All the delivered fetuses were live at birth and slightly less than threequarter (73.3%) their gestational age at delivery was 37 weeks and more. - About three-quarter (75%) of fetuses were with normal birth weight (2.5 kg and more). - The majorities (91.7%) of fetuses were delivered with stable condition without any problems/complications and no admissions to intensive care unit among them have been recorded. : Based on the findings of the present study, it can be concluded that:- The studied pregnant women revealed improvement their level of knowledge as well as their self -care management regarding PIH after implementation of health educational program which inturn reflect positive effect on the maternal and neonatal outcomes. Recommendations Based on the current study, the following recommendations are derived and suggested: I- Recommendations for Hospital, Maternal and Child Health Centers administration: - Plan and develop antenatal health educational classes for all pregnant women to increase their awareness about importance of early antenatal care as well as proper screening for early diagnosis and effective management of PIH to improve their pregnancy outcome. - Ongoing structured planned prenatal program for women with PIH should be developed, established and integrated at women’s health care setting at all levels of care, primary, secondary, and also tertiary level . - Manual booklet containing basic needed information about PIH and its related complications should be provided to all pregnant women with PIH at hospitals and MCH centers. - Postpartum screening of women with PIH provides an opportunity for early detection of chronic hypertension to reduce complications through management after delivery for 12 weeks postpartum. II- Recommendations for nurses: - Provide in-service training programs especially for newly appointed nurses to improve their level of knowledge and practices regarding PIH and its complications. - Provision of training courses for nurses regarding PIH management at all levels of health care. - Health education module should be planned for health care providers to increase and update their knowledge regarding PIH, its management strategies and supporting patients to develop lifestyle changes and maintaining self-care management. III- Recommendation for public education: - Hypertension is one of the most common medical complications of pregnancy. So, establish standard national guidelines which are necessary for screening, continuous monitoring and effective management of PIH. - Mass media and mobilized community organizations should be utilized to disseminate correct and relevant information to women, families, and communities about the importance of PIH, early screening of risk factors and prevention of complications during pregnancy, delivery and postpartum. - Lifestyle programs in schools and workplaces are needed to promote well-being to combat obesity and decrease risk of PIH. IV- Recommendations for further studies: Further research studies are needed in this field related to: - Implementation of PIH educational program to larger sample of pregnant women to increase their awareness. The effect of health educational program on nurse’s knowledge and practices regarding PIH as well as pregnancy outcomes. - Develop and implement evidence based guidelines of nursing care of women with PIH. - Further research should be directed toward investigations of the prevalence of chronic hypertension following PIH.